America: Land of the Free, Home of the Sick?

Perhaps it was Benjamin Franklin who led us astray. “Early to bed, early to rise, makes a man healthy, wealthy, and wise. Though ‘Poor Richard’ may have been on to something, several aspects of this adage have come back to haunt us collectively as Americans.

A team of public health professionals at Columbia University’s Mailman School recently petitioned the Obama administration in the pages of the journal Science to take action at the highest levels to combat the country’s poor and deteriorating health. The scholars point to a recent report commissioned by the Institute of Medicine (IOM) and National Research Council (NRC) which shows American life expectancy falling ever further behind that of peer nations, with similar mediocre results strewn across a host of health indicators.

This part of the story will hardly come as a surprise to physicians, nor to many members of the general public. We have heard this familiar tale before: lack of exercise, poor eating habits, and other dubious lifestyle choices have led to rampant obesity, diabetes, and heart disease, to name just a few maladies. As Franklin would have it, too few of us have been ‘early to bed’, nor ‘early to rise.’

Why is this particular Science piece creating buzz, then? The notable part of the report does not lie in its diagnosis, but in its prescription. Painting with a broad narrative brush, its authors show how generations of American leaders have failed to recognize how deeply-ingrained societal problems like poverty and inequality (not to mention racial discrimination) contribute to very real national ills. America has been making itself sick, but not simply through a collective weakness for fatty foods and aversion to physical activity. Such larger factors as income inequality are also to blame. This is one of the ways in which we have been misguided by Franklin’s advice: personal lifestyle choices alone are not enough to make one healthy. Also important are in many ways knottier quality of life issues, which few presidents have found fit to address.

There’s another respect in which Franklin was wrong or has, at least, perhaps been misinterpreted. He likely was not the first to point out the convenient fact that ‘healthy’ and ‘wealthy’ rhyme. He did, however, popularize this verbal construction and, with it, the implication that, in this case, all good things really do go together. As the Columbia scholars point out, however, the opposite is often true: not only are national affluence and positive health outcomes of questionable correlation, but sometimes becoming richer can actually lead individuals, and nations, to get sicker. Less important than how much wealth a nation generates is how it uses this wealth—and in that, the authors report, the United States has for too long come up short.

So how can we become wiser, and thus healthier? The Columbia team believes the only real solution can come from the top—that is, from the current occupant of the White House. While they are fairly short on specific policy remedies, they are vehement in their belief that only presidential action can steer us on a better course. In this, they are probably right. Many problems in this country are only faced head-on when presidential administrations choose to engage on a topic and, indeed, ‘declare war’ on a figurative villain.

This will only occur, however, if those medicine and public health continue to make their voices heard, highlighting the numerous factors that add up to ill health, and proposing potential solutions. Presidents must act, but they are only likely to do so if authorities in the field speak up, and sustain the call for action. In this way, perhaps, we can, as a nation work to become not only wealthy, but healthy and even wise, as well.

Dan Ehlke, PhD, is an assistant professor of health policy and management at the SUNY Downstate Medical Center School of Public Health in Brooklyn, NY. Dr. Ehlke earned his PhD from Brown University in 2009, and currently focuses his research on the reformation of the American and British health care systems.

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